1
|
Dabic-Stankovic K, Rajkovic K, Stankovic J, Marosevic G, Kolarevic G, Pavicar B. High-dose-rate Brachytherapy Monotherapy in Patients With Localised Prostate Cancer: Dose Modelling and Optimisation Using Computer Algorithms. Clin Oncol (R Coll Radiol) 2024; 36:378-389. [PMID: 38584072 DOI: 10.1016/j.clon.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS Interstitial high-dose-rate brachytherapy (HDR-BT) is an effective therapy modality for patients with localized prostate carcinoma. The objectives of the study were to optimise the therapy regime variables using two models: response surface methodology (RSM) and artificial neural network (ANN). MATERIALS AND METHODS Thirty-one studies with 5651 patients were included (2078 patients presented as low-risk, 3077 patients with intermediate-risk, and 496 patients with high-risk). A comparison of these therapy schedules was carried out using an effective biologically effective dose (BEDef) that was calculated assuming the number of treatment days and dose (D) per day. The modelling and optimization of therapy parameters (BEDef and risk level) in order to obtain the maximum biochemical free survival (BFS) were carried out by the RSM and ANN models. RESULTS An optimal treatment schedule (BFS = 97%) for patients presented with low-risk biochemical recurrence would be D = 26 Gy applied in one application, 2 fractions at least 6 h apart, within an overall treatment time of 1 day (BEDef = 251 Gy) by the RSM and ANN model. For patients presented with intermediate- or high-risk an optimal treatment regime (BFS = 94% and 90%, respectively) would be D = 38 Gy applied in one application, 4 fractions at least 6 h apart, with an overall treatment time of 2 days (BEDef = 279 Gy) by the RSM and ANN models. CONCLUSIONS The RSM and ANN models determine almost the same optimal values for the set of predicted therapy parameters that make a feasible selection of an optimal treatment regime.
Collapse
Affiliation(s)
- K Dabic-Stankovic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - K Rajkovic
- Academy of Applied Preschool Teaching and Health Studies, Krusevac, Serbia; Bijeljina University, Republic of Srpska, Bosnia and Herzegovina.
| | - J Stankovic
- Bijeljina University, Republic of Srpska, Bosnia and Herzegovina; Academy for Applied Studies Belgrade, The College of Health Sciences, Zemun, Serbia.
| | - G Marosevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - G Kolarevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - B Pavicar
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| |
Collapse
|
2
|
Zeng H, Dai J, Cao D, Wang M, Zhao J, Zeng Y, Xu N, Xie Y, Liu H, Zeng H, Sun G, Shen P. Safety and efficacy associated with single-fraction high-dose-rate brachytherapy in localized prostate cancer: a systematic review and meta-analysis. Strahlenther Onkol 2023; 199:525-535. [PMID: 37093230 DOI: 10.1007/s00066-023-02063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/19/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Although single-fraction high-dose-rate brachytherapy (SFHDR) for localized prostate cancer has been tried in clinical trials, relevant medical evidence is currently lacking. It is necessary to systematically analyze the safety and efficacy of SFHDR. METHODS Comprehensive and systematic searches for eligible studies were performed in PubMed, Embase, and the Cochrane Library databases. The primary endpoints included safety and efficacy, represented by toxic effects and biochemical recurrence-free survival (bRFS), respectively. The proportion rates were used as the effect measure for each study and were presented with corresponding 95% confidence intervals (CI) and related 95% prediction interval (PI). Restricted maximum-likelihood estimator (REML) and the Hartung-Knapp method were used in the meta-analysis. RESULTS Twenty-five studies met the inclusion criteria for quantitative analysis, including 1440 patients. The median age of patients was 66.9 years old (62-73 years old) and the median follow-up was 47.5 months (12-75 months). The estimates of cumulative occurrence for severe gastrointestinal (GI) and genitourinary (GU) toxic effects were 0.1% (95% CI 0-0.2%) and 0.4% (95% CI 0-1.2%), and for grade 2 toxic effects were 1.6% (95% CI 0.1-4.7%) and 17.1% (95% CI 5.4-33.5%), respectively. The estimate of 3‑year bRFS was 87.5% (95% CI 84.4-90.3%) and 71.0% (95% CI 63.0-78.3%) for 5‑year bRFS. The pooled bRFS rates for low-risk patients were 99.0% (95% CI 85.2-100.0%) at 3 years and 80.9% (95% CI 75.4-85.9%) at 5 years, and the risk group was found to be statistically correlated with bRFS (3-year bRFS, P < 0.01; 5‑year bRFS, P = 0.04). CONCLUSION SFHDR is associated with favorable tolerability and suboptimal clinical benefit in patients with localized prostate cancer. Ongoing and planned high-quality prospective studies are necessary to verify its safety and efficacy.
Collapse
Affiliation(s)
- Hong Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Minghao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Nanwei Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yandong Xie
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Haolin Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
3
|
Single fraction of HDR brachytherapy for prostate cancer: Results of the SiFEPI phase II prospective trial. Clin Transl Radiat Oncol 2022; 37:64-70. [PMID: 36093342 PMCID: PMC9449500 DOI: 10.1016/j.ctro.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
LDR brachytherapy is a validated therapy for low-risk prostate cancer. HDR brachytherapy aims to decrease urinary side effects. A single fraction of 20 Gy HDR brachytherapy leads to sub-optimal biochemical control. No Grade 3 urinary/digestive toxicity after a single fraction of HDR brachytherapy. 2 fractions of HDR brachytherapy constitute a promising approach.
Purpose To report the results of the Single Fraction Early Prostate Irradiation (SiFEPI) phase 2 prospective trial. Materials/Methods The SiFEPI trial (NCT02104362) evaluated a single fraction of high-dose rate brachytherapy (HDB) for low- (LR) and favorable-intermediate (FIR) risk prostate cancers. After rectal spacer placement, a single fraction of 20 Gy was delivered to the prostate. Oncological outcome (biochemical (bRFS) and local (lRFS) relapses, disease-free (DFS) and overall (OS) survivals and toxicity (acute/late genito-urinary (GU), gastro-intestinal (GI) and sexual (S) toxicities were investigated. Results From 03/2014 to 10/2017, 35 pts were enrolled, of whom 33 were evaluable. With a median age of 66 y [46–79], 25 (76 %) and 8 (24 %) pts were LR and FIR respectively. With a MFU of 72.8 months [64–86], 6y-bRFS, lRFS and mRFS were 62 % [45–85], 61 % [44–85] and 93 % [85–100] respectively while 6y-DFS, CSS and OS were 54 % [37–77], 100 % and 89 % [77–100] respectively. Late GU, GI and S toxicities were observed in 11 pts (33 %;18G1), 4 pts (12 %;4G1) and 7 pts (21 %;1G1,5G2,1G3) respectively. Biochemical relapse (BR) was observed in 11 pts (33 %;7LR,4FIR) with a median time interval between HDB and BR of 51 months [24–69]. Nine of these pts (82 %) presented a histologically proven isolated local recurrence. Conclusions Long-term results of the SiFEPI trial show that a single fraction of 20 Gy leads to sub-optimal biochemical control for LR/FIR prostate cancers. The late GU and GI toxicity profile is encouraging, leading to consideration of HDB as a safe irradiation technique.
Collapse
|
4
|
Milligan K, Van Nest SJ, Deng X, Ali-Adeeb R, Shreeves P, Punch S, Costie N, Pavey N, Crook JM, Berman DM, Brolo AG, Lum JJ, Andrews JL, Jirasek A. Raman spectroscopy and supervised learning as a potential tool to identify high-dose-rate-brachytherapy induced biochemical profiles of prostate cancer. JOURNAL OF BIOPHOTONICS 2022; 15:e202200121. [PMID: 35908273 DOI: 10.1002/jbio.202200121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
High-dose-rate-brachytherapy (HDR-BT) is an increasingly attractive alternative to external beam radiation-therapy for patients with intermediate risk prostate cancer. Despite this, no bio-marker based method currently exists to monitor treatment response, and the changes which take place at the biochemical level in hypo-fractionated HDR-BT remain poorly understood. The aim of this pilot study is to assess the capability of Raman spectroscopy (RS) combined with principal component analysis (PCA) and random-forest classification (RF) to identify radiation response profiles after a single dose of 13.5 Gy in a cohort of nine patients. We here demonstrate, as a proof-of-concept, how RS-PCA-RF could be utilised as an effective tool in radiation response monitoring, specifically assessing the importance of low variance PCs in complex sample sets. As RS provides information on the biochemical composition of tissue samples, this technique could provide insight into the changes which take place on the biochemical level, as result of HDR-BT treatment.
Collapse
Affiliation(s)
- Kirsty Milligan
- Department of Physics, University of British Columbia, Kelowna, Canada
| | - Samantha J Van Nest
- Trev and Joyce Deeley Research Centre, BC Cancer-Victoria, Victoria, Canada
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Xinchen Deng
- Department of Physics, University of British Columbia, Kelowna, Canada
| | - Ramie Ali-Adeeb
- Department of Physics, University of British Columbia, Kelowna, Canada
| | - Phillip Shreeves
- Department of Mathematics and Statistics, University of British Columbia, Kelowna, Canada
| | - Samantha Punch
- Trev and Joyce Deeley Research Centre, BC Cancer-Victoria, Victoria, Canada
| | - Nathalie Costie
- Trev and Joyce Deeley Research Centre, BC Cancer-Victoria, Victoria, Canada
| | - Nils Pavey
- Trev and Joyce Deeley Research Centre, BC Cancer-Victoria, Victoria, Canada
| | - Juanita M Crook
- Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer, Kelowna, Canada
- Department of Radiation Oncology, University of British Columbia, Kelowna, Canada
| | - David M Berman
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Canada
| | | | - Julian J Lum
- Trev and Joyce Deeley Research Centre, BC Cancer-Victoria, Victoria, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Jeffrey L Andrews
- Department of Mathematics and Statistics, University of British Columbia, Kelowna, Canada
| | - Andrew Jirasek
- Department of Physics, University of British Columbia, Kelowna, Canada
| |
Collapse
|
5
|
Brachytherapy: An emblematic example of extreme hypofractionated regimen. Cancer Radiother 2021; 26:611-615. [PMID: 34728114 DOI: 10.1016/j.canrad.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022]
Abstract
In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3Gy), then ultra (dose/fraction: 5.2 to 6.1Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20Gy/fraction), the use of a single fraction of 19 to 23Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.
Collapse
|
6
|
Strouthos I, Karagiannis E, Zamboglou N, Ferentinos K. High-dose-rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome. Cancer Rep (Hoboken) 2021; 5:e1450. [PMID: 34164950 PMCID: PMC8789612 DOI: 10.1002/cnr2.1450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background High‐dose‐rate brachytherapy (HDR BRT) has been enjoying rapid acceptance as a treatment modality offered to selected prostate cancer patients devoid of risk group, employed either in monotherapy setting or combined with external beam radiation therapy (EBRT) and is currently one of the most active clinical research areas. Recent findings This review encompasses all the current evidence to support the use of HDR BRT in various clinical scenario and shines light to the HDR BRT rationale, as an ultimately conformal dose delivery method enabling safe dose escalation to the prostate. Conclusion Valid long‐term data, both in regard to the oncologic outcomes and toxicity profile, support the current clinical indication spectrum of HDR BRT. At the same time, this serves as solid, rigid ground for emerging therapeutic applications, allowing the technique to remain in the spotlight alongside stereotactic radiosurgery.
Collapse
Affiliation(s)
- Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Clinical Faculty, School of Medicine, European University Cyprus, Nicosia, Cyprus
| |
Collapse
|
7
|
Roy A, Brenneman RJ, Hogan J, Barnes JM, Huang Y, Morris R, Goddu S, Altman M, Garcia-Ramirez J, Li H, Zoberi JE, Bullock A, Kim E, Smith Z, Figenshau R, Andriole GL, Baumann BC, Michalski JM, Gay HA. Does the sequence of high-dose rate brachytherapy boost and IMRT for prostate cancer impact early toxicity outcomes? Results from a single institution analysis. Clin Transl Radiat Oncol 2021; 29:47-53. [PMID: 34136665 PMCID: PMC8182264 DOI: 10.1016/j.ctro.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022] Open
Abstract
The optimal sequence of HDR-BT boost and EBRT for prostate cancer is unclear. We compared early toxicity based on the timing of HDR-BT boost. The timing of HDR-BT was not based on any specific patient or clinical factors. We found no difference in early GI/GU toxicity between the two groups. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
Background We present the first report comparing early toxicity outcomes with high-dose rate brachytherapy (HDR-BT) boost upfront versus intensity modulated RT (IMRT) upfront combined with androgen deprivation therapy (ADT) as definitive management for intermediate risk or higher prostate cancer. Methods and Materials We reviewed all non-metastatic prostate cancer patients who received HDR-BT boost from 2014 to 2019. HDR-BT boost was offered to patients with intermediate-risk disease or higher. ADT use and IMRT target volume was based on NCCN risk group. IMRT dose was typically 45 Gy in 25 fractions to the prostate and seminal vesicles ± pelvic lymph nodes. HDR-BT dose was 15 Gy in 1 fraction, delivered approximately 3 weeks before or after IMRT. The sequence was based on physician preference. Biochemical recurrence was defined per ASTRO definition. Gastrointestinal (GI) and Genitourinary (GU) toxicity was graded per CTCAE v5.0. Pearson Chi-squared test and Wilcoxon tests were used to compare toxicity rates. P-value < 0.05 was significant. Results Fifty-eight received HDR-BT upfront (majority 2014–2016) and 57 IMRT upfront (majority 2017–2018). Median follow-up was 26.0 months. The two cohorts were well-balanced for baseline patient/disease characteristics and treatment factors. There were differences in treatment sequence based on the year in which patients received treatment. Overall, rates of grade 3 or higher GI or GU toxicity were <1%. There was no significant difference in acute or late GI or GU toxicity between the two groups. Conclusion We found no significant difference in GI/GU toxicity in intermediate-risk or higher prostate cancer patients receiving HDR-BT boost upfront versus IMRT upfront combined with ADT. These findings suggest that either approach may be reasonable. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
Collapse
Affiliation(s)
- Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacob Hogan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Yi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Morris
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael Altman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacqueline E. Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Arnold Bullock
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Zachary Smith
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Figenshau
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Gerald L. Andriole
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
- Corresponding author at: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, LL, Campus Box 8224, St. Louis, MO 63110, United States.
| |
Collapse
|
8
|
Martell K, Kollmeier MA. Complications and side effects of high-dose-rate prostate brachytherapy. Brachytherapy 2021; 20:966-975. [PMID: 33612395 DOI: 10.1016/j.brachy.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe technical challenges and complications encountered during and after high-dose-rate prostate brachytherapy (HDR-BT) and review management of these complications. METHODS AND MATERIALS The authors performed a systematic review of the literature on toxicities encountered after prostate HDR-BT +/- external beam radiotherapy. A total of 397 studies were identified, of which 64 were included. A focused review of literature regarding the management of acute and late toxicities also performed. RESULTS Most acute toxicities include grade 0-2 genitourinary and gastrointestinal toxicity. Overall, Grade 3+ Common Terminology Criteria for Adverse Events toxicity after HDR-BT was low [genitourinary: 0-1%; gastrointestinal 0-3%]. Rates of fistula formation were <1%, and radiation cystitis/proctitis were <14% and more commonly reported in cohorts treated with HDR-BT boost and external beam radiotherapy. CONCLUSIONS HDR-BT both as monotherapy or combined with external beam radiotherapy for prostate cancer is well tolerated. Serious complications are rare.
Collapse
Affiliation(s)
- Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
9
|
Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control. J Contemp Brachytherapy 2021; 13:12-17. [PMID: 34025731 PMCID: PMC8117711 DOI: 10.5114/jcb.2021.103581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure. Material and methods Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2). Results Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment. Conclusions Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.
Collapse
|
10
|
A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer. J Contemp Brachytherapy 2020; 12:193-200. [PMID: 32395145 PMCID: PMC7207227 DOI: 10.5114/jcb.2020.94492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/23/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. Material and methods Published HDR-BT clinical results for low- and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. Results We obtained a value of α/β = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. Conclusions The α/β obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/β explains reasonably well the data available in the region of high doses per fraction considered.
Collapse
|